The Impact of Epiretinal Membrane in Neovascular Age-Related Macular Degeneration Treatment: A Spectral-Domain Optical Coherence Tomography Study

Multimodal imaging of epiretinal neovascularization associated with type 3 macular neovascularization

PURPOSE

To report a case of type 3 macular neovascularization presenting with an epiretinal neovascularization.

METHODS

Case report.

RESULTS

A 65-year-old gentleman presented with complaints of reduced vision in the left eye (LE) having a best corrected visual acuity (BCVA) of 20/200. Based on fundus examination and multimodal imaging findings he was diagnosed with type 3 macular neovascularization (MNV). An additional unusual finding was the presence of an epiretinal membrane (ERM) and epiretinal neovascularization (ERN), with the latter finding being confirmed on optical coherence tomography angiography (OCTA). He underwent three doses of intravitreal ranibizumab injection following which there was reduction in the epiretinal vascularity.

CONCLUSIONS

Multimodal imaging of this case highlights the presence of epiretinal neovascularization associated with type 3 MNV, which has not been reported previously.

Epiretinal membrane appearance or progression after intravitreal injection in age-related macular degeneration

BACKGROUND

The purpose of this study is to evaluate the influence of anti-vascular endothelial growth factor (VEGF) in the appearance or progression of epiretinal membranes (ERMs) in age-related macular degeneration (ARMD) and investigate confounding factors causing ERMs.

METHODS

Seventy-six eyes that were treated for more than 36 months from the first anti-VEGF injection were assessed. Binary logistic regression analysis was performed between smoking, lens status, subretinal hemorrhage, posterior vitreous detachment (PVD) status, peripheral retinal degeneration, type of AMD, conditions of contralateral eye, and the number of injections as independent variables and appearance or progression of ERMs during 36 months as dependent variables.

RESULTS

The presence of vitreomacular adhesion (VMA) or development of PVD during the observation period was significantly associated (Odds ratio [OR]: 5.77; 95% confidence interval [CI], 1.72-19.4; p = 0.005) with the appearance or progression of ERMs. Moreover, peripheral retinal degeneration was significantly associated (OR: 3.87; 95% CI, 1.15-13.0; p = 0.029). Injection number of anti-VEGF was not significantly associated (OR: 1.02; 95% CI, 0.90-1.16; p = 0.72).

CONCLUSION

This study suggests possibilities that anti-VEGF injections alone are unable to cause the development of ERMs, that VMA or developing PVD has a prior impact on the developing ERMs in ARMD similar to that of idiopathic ERMs, and that peripheral retinal degenerations and vitreomacular adhesion were both related to ERMs development and pathogenesis of ARMD.

Comparison of the effect of ranibizumab and dexamethasone implant in diabetic macular edema with concurrent epiretinal membrane

OBJECTIVE

To compare the efficacy and safety of intravitreal ranibizumab (RZB) injections and intravitreal dexamethasone (DEX) implant in diabetic macular edema (DME) with concurrent epiretinal membrane (ERM).

METHODS

This was a retrospective, observational, comparative study. Medical records of DME patients with concurrent ERM were retrospectively reviewed. Seventeen eyes of 16 patients treated with 3 consecutive monthly RZB injections (RZB group) and 22 eyes of 18 patients treated with a DEX implant (DEX group) were included. The groups were compared at baseline, 1st, 2nd, 3rd and 4th months in terms of best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP).

RESULTS

Eighteen of the 39 eyes (46.1%) were phakic at baseline, 9 (52.9%) of which were treated with RZB, whereas 9 (40.9%) were treated with DEX implant (P=0.528). Although CMT improved significantly in both the RZB and DEX groups (P<0.001); the trend was different (P=0.003). The mean change in CMT at 1month in the DEX group was greater (DEX: 188.2±142.7μm; RZB: 95.7±110.7μm; P=0.034); it was in favor of RZB group at the 3rd and 4th months (DEX: -52.7±86.9μm; RZB: 1.4±31.4μm; P=0.012. DEX: -63±67.3μm; RZB: -5.8±43.9μm; P=0.004, respectively). BCVA improved significantly in both groups (P<0.001). There was no statistical difference between the groups with regard to gain in BCVA or IOP change throughout the study period (P=0.572, P=0.064, respectively).

CONCLUSION

Both RZB and DEX are effective in improving anatomical and visual outcomes in DME with concurrent ERM. The DEX group was associated with a prompt anatomic response, but with a gradual decrease from 3rd month.